Correction of Lower Limb Deformities Using Ilizarov's Technique

Background

India accounts for approximately 10 million orthopaedically handicapped children and adults with limb deformity. Ilizarov ring fixator could treat most of these deformities.

Methods

Twenty cases of deformities of lower limb managed with Ilizarov technique during period between March 2001 and February 2003 were studied.

Results

55% were in the age group of 11-30 years. Out of the 20 cases studied, 6 were congenital talipes equino varus, 8 were fixed flexion deformity of knee, 4 were equines deformity of the ankle and 2 were malunited fracture shaft of tibia.4 patients who had recurrence were operated for fixed flexion deformity of the knee. The main complication encountered was pin tract infection, which was seen in 15(75%) cases. In 16(80%) cases, the results were excellent with no recurrence of deformity and patients were able to walk independently. In 4 (20%) cases, recurrence was mild to moderate (10 to 20) but all of them were able to ambulate idependently and carry out their routine activities.

Conclusion

Ilizarov ring fixator is a superior compared to conventional methods for correction of deformities of lower limb.Key Words: Ilizarov method, Ligamentotaxis, Distraction     

Infektionsepidemiologische Ausbildungs- und Trainingsprogramme

The German Field Epidemiology Training Programme (FETP) and the European Programme for Intervention Epidemiology Training (EPIET) were founded to develop a network of epidemiologists for the surveillance and control of communicable diseases. During their 2-year training, FETP or EPIET fellows are based at the Robert Koch-Institut or other European host institutes and have to conduct outbreak investigations, carry out surveillance and research projects and publish the results. Since 1995, all 22 FETP and 94 EPIET fellows have conducted and published numerous outbreak investigations, surveillance and research projects, for example on pathogens inducing salmonellosis, influenza, SARS or avian influenza. Currently, 70% of FETP and EPIET alumni are working in key positions in communicable disease control on a regional, national or international level. The German FETP and the European EPIET programme offer high quality practical training in applied epidemiology. The expert knowledge of the alumni of both training programmes will be incorporated into the new European Centre for Disease Control (ECDC) and determine the future direction of infectious disease epidemiology in Germany and Europe.     

Chemotherapy in recurrent noncystic low-grade astrocytomas of the cerebrum in children

Six children with grade II astrocytomas were treated with combination chemotherapy consisting of 1,3 bis(2-chloroethyl) 1-nitrosourea (BCNU). Vincristine (VCR), intrathecal Methotrexate (i.t. MTX), and Dexamethasone. Of the children, 3 showed a partial remission, and 1 other showed clinical improvement. Our data suggest that chemotherapy is effective in low-grade astrocytomas, and there is now a need for larger trials in low-grade astrocytomas to document the role of chemotherapy accurately in these tumors. It is suggested that trials of chemotherapy as adjuvant to surgery and radiotherapy should be initiated.     

Ventriculoperitoneal shunt infection due to Serratia marcescens

Serratia marcescens is an opportunistic Gram-negative bacillus that is most often associated with infections of the respiratory tract, urinary tract, wounds, and bloodstream. Infections of the central nervous system (CNS) with this pathogen are exceedingly infrequent. Even more rare is the association of S. marcescens with infections of ventriculoperitoneal (VP) shunts. To the best of our knowledge, we describe in this report not only the first case of a VP shunt infection by S. marcescens in an adult, but also the first case of a VP shunt infection by this organism in the absence of bowel perforation.     

Delay of neutrophil apoptosis in acute coronary syndromes

Apoptosis of polymorphonuclear neutrophils (PMN) is currently discussed as a key event in the control of inflammation. This study determined PMN apoptosis and its underlying mechanisms in controls (C), patients with stable (SAP) or unstable angina (UAP), and with acute myocardial infarction (AMI). Blood was drawn from 15 subjects of each C, SAP, UAP, and AMI. Apoptosis was measured by flow cytometry in isolated PMN (propidium iodide staining) and PMN from whole blood (CD16, FcgammaRIII). Serum cytokines were determined by enzyme-linked immunosorbent assay. Apoptosis of isolated PMN was delayed significantly in acute coronary syndromes (ACS) as compared with SAP or C (C, 51.2+/-12.6%; SAP, 44.9+/-13.6%; UAP, 28.4+/-10.1%; AMI, 20.3+/-8.5%; AMI or UAP vs. SAP or C, P<0.001). These results were confirmed by measurement of PMN apoptosis in cultured whole blood from patients and controls. Moreover, serum of patients with ACS markedly reduced apoptosis of PMN from healthy donors. Analysis of patients' sera revealed significantly elevated concentrations of tumor necrosis factor alpha, interferon-gamma (IFN-gamma), granulocyte macrophage-colony stimulating factor (GM-CSF), and interleukin (IL)-1beta in ACS (vs. C and SAP). IFN-gamma, GM-CSF, and IL-1beta significantly delayed PMN apoptosis in vitro. Furthermore, coincubation of PMN with adenosine 5'-diphosphate-activated platelets significantly inhibited PMN apoptosis as compared with coculture with unstimulated platelets. This study demonstrates a pronounced delay of PMN apoptosis in UAP and AMI, which may result from increased serum levels of IFN-gamma, GM-CSF, and IL-1beta and from enhanced platelet activation. Therapeutical modulation of these determinants of PMN lifespan may provide a new concept for the control of inflammation in ACS.     

Effect of short-term Psychiatric Intervention in Cancer Patients

A total of 50 patients undergoing cancer treatment at Malignant Disease Treatment Centre were included in the present study aimed at evaluating the psychological status of cancer patients. All patients filled a specially designed proforma and the following psychological questionnaires : General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, PGI General Well-being Scale and Quality of Life Scale. Analysis of the results showed that 22 (44%) of the cancer patients had psychiatric disorders and this number had reduced to 12 (24%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating Scale for depression. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in cancer patients.Key Words: Cancer, Depression, Psychiatric morbidity     

The use of embryonic stem cells for regulatory developmental toxicity testing in vitro--the current status of test development

The future chemical policy of the European Union as well as the 7th amendment of the cosmetic directive is calling for the development of alternative tests to animal experimentation for toxicological safety testing. In the field of embryotoxicity one of the most promising in vitro models are based on embryonic stem cells. The embryonic stem cell test has already been validated in comparison to in vivo results in an international blind collaboration study. The presented review is discussing the use, limitations and further needs for the test in order to be fully suitable for regulatory acceptance. In this context, it is summarized which requirements for an in vitro embryotoxicity test have to be fulfilled for regulatory toxicity testing. In addition, an overview about the current status of test development of other embryonic stem cell tests is presented. Several workshops have reviewed the progress of in vitro tests for developmental toxicity testing. A general consensus of these workshops has been that one single test will not be sufficient to cover all manifestations of developmental toxicity. The establishment of a test battery for developmental toxicity is required. This will be even more challenging since the principles of a composing test strategy and its validation have not been defined yet. Finally, the unique possibility of combining the human embryonic stem cell technology and the microarray techniques might lead to a deeper understanding of the toxicological mechanisms of human developmental toxicants.     

ATM polymorphisms as risk factors for prostate cancer development

The risk of prostate cancer is known to be elevated in carriers of germline mutations in BRCA2, and possibly also in carriers of BRCA1 and CHEK2 mutations. These genes are components of the ATM-dependent DNA damage signalling pathways. To evaluate the hypothesis that variants in ATM itself might be associated with prostate cancer risk, we genotyped five ATM variants in DNA from 637 prostate cancer patients and 445 controls with no family history of cancer. No significant differences in the frequency of the variant alleles at 5557G>A (D1853N), 5558A>T (D1853V), ivs38-8t>c and ivs38-15g>c were found between the cases and controls. The 3161G (P1054R) variant allele was, however, significantly associated with an increased risk of developing prostate cancer (any G vs CC OR 2.13, 95% CI 1.17-3.87, P=0.016). A lymphoblastoid cell line carrying both the 3161G and the 2572C (858L) variant in the homozygote state shows a cell cycle progression profile after exposure to ionising radiation that is significantly different to that seen in cell lines carrying a wild-type ATM gene. These results provide evidence that the presence of common variants in the ATM gene, may confer an altered cellular phenotype, and that the ATM 3161C>G variant might be associated with prostate cancer risk.     

Spina bifida

Zusammenfassung Trotz fortgeschrittener Pränataldiagnostik mittels Ultraschall, -Fetoprotein-Bestimmung sowie der Amniozentese liegt die Prävalenz der Spina bifida bei 2,6/1000 Geburten. Das breite Spektrum der klinischen Aspekte dieses Krankheitsbildes gebietet eine interdisziplinäre Behandlung. Ziel der Therapie muss das Erreichen einer maximalen Integration in der Gesellschaft mit größtmöglicher Beweglichkeit und Selbständigkeit im täglichen Leben sein. Die Aufgabe des Orthopäden liegt in der Vermeidung/Behandlung von Gliedmaßenfehlstellungen an Füßen, Kniegelenken, Hüften sowie der Wirbelsäule. Spina-bifida-Kinder sind zu 90% mit Fußfehlstellungen behaftet, 40–50% bilden während ihres Wachstums eine Hüftfehlstellung evtl. mit Muskelkontrakturen aus, und Wirbelsäulendeformierungen treffen 50–80% der betroffenen Kinder. Keine dieser orthopädischen Probleme wächst sich aus; alle müssen so früh als möglich einer Spina-bifida-erfahrenen ärztlichen Behandlung zugeführt werden. Deren Prinzipien werden im vorliegenden Artikel dargestellt.

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